Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Therapy Letter
88 (
5
); 671-674
doi:
10.25259/IJDVL_891_2021
pmid:
35962519

Excimer light therapy for the treatment of residual depigmentation after at least six months of surgical grafting techniques in stable vitiligo: Results of a retrospective case series

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, Delhi, India
Corresponding author: Dr. Somesh Gupta, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, Delhi, India. someshgupta@aiims.edu
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Yadav D, Gupta S. Excimer light therapy for the treatment of residual depigmentation after at least six months of surgical grafting techniques in stable vitiligo: Results of a retrospective case series. Indian J Dermatol Venereol Leprol 2022;88:671-4.

Sir,

Repigmentation is often incomplete after various surgical grafting techniques in vitiligo due to inadequate pigment dispersion. Treatment of these residual depigmented areas is challenging, often requiring repeat surgical intervention.1 Early use of excimer therapy in the post-surgical period have been found to be beneficial. However, there is a lack of data on its efficacy in patches remaining long after surgery. We undertook a retrospective review of the efficacy of excimer light for residual depigmented patches remaining after at least six months of surgical grafting techniques in stable vitiligo. A total of 22 cases were included with mean age of 22.7 years, male: female ratio of 1:4.5 and had undergone transplantation surgery at least before six months [Table 1]. The majority of the cases had segmental vitiligo (14 cases, 63.6%) with mean duration of illness of 6.4 years and skin phototype IV–V. The last surgical interventions included both cellular (non-cultured epidermal cell suspension: 11 cases; non-cultured epidermal cell suspension with extracted hair follicle outer root sheath cell suspension: six cases) and tissue (suction blister graft: three cases; punch graft: two cases) grafting methods. The mean duration since the last surgical intervention was 10.1 ± 5.2 months. All cases had received an adequate trial of medical management including phototherapy prior to surgical intervention. In the post-surgery period, they were advised tacrolimus 0.1% ointment once-daily application and daily sun exposure for at least ten minutes, starting one to three weeks after surgery. The excimer light was given using a hand-held xenon chloride lamp (Excipelx®, Clarteis, Valbonne, France) two to three times per week on non-consecutive days. The initial dose given was based on the site involved (head and neck: 100 mJ/cm2, trunk: 150 mJ/cm2, upper limb: 200 mJ/cm2, lower limb: 200 mJ/cm) with increment by 50 mJ depending on the erythema at 48 hours. Tacrolimus 0.1% ointment and fluocinolone acetonide 0.1% cream were given concomitantly in 20 and one case respectively. The mean number of sessions received were 23.7 ± 10.3, cases who had received less than ten sessions of excimer therapy were excluded. Efficacy was measured as patient and investigator global assessment (subjective based on the photographic review, single-blinded observer), in terms of percentage improvement from baseline. The mean ± SD percentage improvement on patient global assessment and investigator global assessment were 27.6 ± 28.6 (range: 0–90%) and 27.6 ± 29.2 (range: 0–90%), respectively [Figure 1ac] [Table 1]. On the evaluation of site-wise treatment response, facial lesions (n = 12) showed the maximum improvement with mean improvement of 37.5% ± 27.1% and 38.3% ± 27% on patient and investigator assessment, respectively [Figures 2a-b and 3a-b] [Table 1]. Post-treatment hyperpigmentation was seen in one case. No other major side effects were noted.

Table 1:: Clinical and treatment details of cases (n = 22)
Parameters Mean ± standard deviation/median (range)
Total cases Included: 22
Excluded: 4 (<10 sessions of excimer light therapy)
Age 22.7 ± 4.7 years
Male: female 1:4.5
Type of vitiligo Segmental: 14 (63.6%)
Non-segmental (acrofacial 5, vulgaris 1): 6 (27.3%)
Mixed: 1 (4.5%)
Focal: 1 (4.5%)
Total disease duration 6.4 ± 2.5 years
Skin phototype IV: 7 (31.8%)
V: 15 (68.2%)
Sites involved Face: 12
Upper limbs: 1
Lower limbs: 3
Trunk: 5
Acral sites: 4
Previous surgical treatment Non-cultured epidermal cell suspension: 11 (50%)
Non-cultured extracted hair follicle outer root sheath cell suspension: 6 (27.3%)
Suction blister grafting: 3 (13.6%)
Punch grafting: 2 (9.1%)
Duration since last surgery 10.1 ± 5.2 months
Concomitant therapy Tacrolimus: 19
Fluocinolone: 1
Tacrolimus + fluocinolone: 1
No treatment: 1
No. of excimer sessions 23.7 ± 10.3 (10–42)
Dose of excimer (median, range) Face: 750 (250–1100)
Upper limbs: 450
Lower limbs: 1050 (750–1500)
Trunk: 550 (300–1000)
Acral sites: 700 (500–1000)
Patient assessment Global: 27.6 ± 28.6 (0–90%)
Face: 37.5 ± 27.1 (0–90%)
Upper limbs: 0
Lower limbs: 16.6 ± 23.4 (0–50%)
Trunk: 24 ± 28 (10–80%)
Acral sites: 0
Physician assessment Global: 27.6 ± 29.2 (0–90%)
Face: 38.3 ± 27 (0–90%)
Upper limbs: 0
Lower limbs: 20 ± 28.2 (0–60%)
Trunk: 20 ± 20.5 (0–70%)
Acral sites: 0
Figure 1:: (a) Segmental vitiligo before surgical intervention. (b) Residual depigmented areas 12 months after non-cultured epidermal cell suspension (c) A >50% repigmentation after 35 sessions of excimer light therapy
Figure 2:: (a) Residual depigmented area 10 months after non-cultured epidermal cell suspension. (b) >50% repigmentation after 42 sessions of excimer light therapy
Figure 3:: (a) Residual depigmented area 12 months after suction blister grafting. (b) A <50% repigmentation after 20 sessions of excimer light therapy

Incomplete repigmentation is often encountered after transplantation surgery for vitiligo. Various causes include contraction or displacement of graft, incomplete dermabrasion of recipient site, inadequate dispersion of cellular graft material, insufficient pigment dispersion and autoimmunity.1,2 Such residual depigmented areas also known as achromic fissures are difficult to manage and often demand repetition of surgical procedures. Targeted phototherapy in the form of excimer therapy has been found to be effective in achieving greater pigmentation when combined with surgical grafting techniques.3 In addition, excimer therapy reduces the odds of developing perigraft halo or achromic fissures.4 The results were similar when compared to narrowband ultraviolet B light therapy.5 However, in all these studies excimer therapy was given early in the course of treatment, usually within one to two weeks after the surgery.3-5 As far as ascertained, no study evaluated the role of excimer therapy for residual depigmented lesions long after the surgical procedure. We tried excimer light for the management of such lesions remaining after six months or more since the last surgical procedure, who had received an adequate trial of non-targeted phototherapy (psoralen and ultraviolet A or narrow-band ultraviolet B) prior to surgical intervention. Around half of these cases (ten cases, 45.4%) had undergone surgical intervention more than once in the past. Though we find less than 30% overall response, excimer therapy did induce good pigmentation (>50% repigmentation) in seven cases (31.2%) leading to acceptable cosmetic results along with reducing morbidity associated with repeat surgical intervention. The repeat surgical intervention could be avoided in four cases. Of note, lesions on acral sites (hands and feet) showed minimal improvement. Sheth et al. found a median improvement of 9% with excimer light combined with punch grafting in acral vitiligo.6 Excimer lamp is a good and convenient tool for the localised area of depigmentation. It delivers the desired energy in a quick time and is patient-friendly. Results with excimer light are comparable with phototherapy in the early postoperative period. However, there is a lack of literature on the comparison between the two modalities in the late post-surgical phase. The rationale of using excimer light at least six months after the last surgical intervention in the present study was to see if it could induce pigmentation and prevent the need for re-surgery. In conclusion, late therapy (at least six months after surgery) with excimer light was not effective in the majority of our cases, repeat surgery could be avoided in only four cases. However, future long term prospective studies are needed to determine its efficacy and also compare with other modalities like ultraviolet B phototherapy. Our study had various limitations including small sample size, retrospective nature and lack of control group.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , . Tissue grafts in vitiligo surgery - past, present, and future. Indian J Dermatol. 2009;54:150-8.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , , , , et al. Autoimmune destruction of skin melanocytes by perilesional T cells from vitiligo patients. J Invest Dermatol. 2009;129:2220-32.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , , , . The additive effect of excimer laser on non-cultured melanocyte-keratinocyte transplantation for the treatment of vitiligo: a clinical trial in an Iranian population. J Eur Acad Dermatol Venereol. 2015;29:745-51.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , . Long-term results of split-skin grafting in combination with excimer laser for stable vitiligo. Dermatol Surg. 2010;36:499-505.
    [CrossRef] [PubMed] [Google Scholar]
  5. , , , , , , et al. A randomized comparison of excimer laser versus narrow-band ultraviolet B phototherapy after punch grafting in stable vitiligo patients. J Eur Acad Dermatol Venereol. 2012;26:690-5.
    [CrossRef] [PubMed] [Google Scholar]
  6. , , , , , , et al. Efficacy of narrowband ultraviolet B versus excimer radiation in repigmenting vitiligo after minigrafting on the distal arms. J Am Acad Dermatol. 2012;67:318-20.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
2,235

PDF downloads
515
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections